Basic Information
| Provider Information | |||||||||
| NPI: | 1073706651 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 950248 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024895730 | ||||||||
| FaxNumber: | 5024895753 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 NEW MOODY LANE | ||||||||
| Address2: | |||||||||
| City: | LAGRANGE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022225388 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2007 | ||||||||
| LastUpdateDate: | 01/26/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 11013843A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 43724 | KY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.